Breast carcinoma vs other adenocarcinomas

A panel of markers is useful in identifying adenocarcinoma as arising from a breast primary.

Gross cystic disease fluid protein (GCDFP) has a high specificity (when salivary gland, skin adnexal and prostatic carcinomas are excluded, the specificity is 98%⁴) but a relatively low sensitivity of 62-77%⁴. GCDFP and WT-1 are useful in differentiating breast from non-mucinous ovarian carcinoma. If an ovarian primary can be excluded on clinical grounds, positivity for either GCDFP or steroid receptors (ER and PR) raises the sensitivity for breast carcinoma to 83%. The published data on steroid receptors in pulmonary and gastric carcinoma is conflicting, but, overall, positivity favours breast carcinoma. The study by Lee et al found a specificity for breast carcinoma of 84% in cases positive for both ER and PR¹. In one study, breast carcinomas that were negative for GCDFP and steroid receptors were (with the exception of one case) negative for CEA²: this subgroup analysis needs to be interpreted with caution. Positivity for CK20 largely excludes a breast primary. Positivity for TTF-1 or CDX-2 also exclude a breast primary.

	breast versus other	GCDFP-15 positivity indicates breast, negativity uninformative
	breast versus lung	TTF-1 positivity indicates lung, negativity uninformative
	breast versus ovarian serous or transitional cell	WT-1 positivity indicates ovarian5, negativity favours breast
	breast versus ovarian mucinous	CK20 positivity indicates ovarian CA125 negativity favours breast, positivity uninformative
	breast versus stomach	ER positivity favours breast CK20 positivity favours stomach CDX-2 positivity indicates stomach

References

¹Lee, B. H., J. L. Hecht, et al. (2002). "WT1, estrogen receptor, and progesterone receptor as markers for breast or ovarian primary sites in metastatic adenocarcinoma to body fluids." Am J Clin Pathol 117(5): 745-50.

²Kaufmann, O., T. Deidesheimer, et al. (1996). "Immunohistochemical differentiation of metastatic breast carcinomas from metastatic adenocarcinomas of other common primary sites." Histopathology 29(3): 233-40.

³Kaufmann, O., S. Kother, et al. (1998). "Use of antibodies against estrogen and progesterone receptors to identify metastatic breast and ovarian carcinomas by conventional immunohistochemical and tyramide signal amplification methods." Mod Pathol 11(4): 357-63.

⁴Lerwill, M. F. (2004). "Current practical applications of diagnostic immunohistochemistry in breast pathology." Am J Surg Pathol 28(8): 1076-91.

⁵Recine, M. A., M. T. Deavers, et al. (2004). "Serous carcinoma of the ovary and peritoneum with metastases to the breast and axillary lymph nodes: a potential pitfall." Am J Surg Pathol 28(12): 1646-51.

This page last revised 6.1.2005.

©SMUHT/PW Bishop